'Why I wish I hadn't delayed my smear test'

'Why I wish I hadn't delayed my smear test'

By JILL PARSONS

Last updated at 12:18 08 June 2007

Michelle Vinall cannot recall what she did with the letter inviting her to book her three-yearly smear test at her local health centre. Nor can she remember where the reminder went, although she suspects it may have ended up in the bin.

'I was busy, with a hectic job, two children, a husband, a puppy, and a house to run, and it was yet one more thing to organise.

'I'd never been ill, didn't feel there was anything wrong and it seemed to be too much hassle to make the appointment. Now, of course, I do wonder how different my life may have been if I'd made more effort.'

Michelle, a 36-year-old teaching assistant from Staines, Berkshire, waited almost a year after it was overdue before having a smear test.

Within months, she had been diagnosed with cervical cancer and had to undergo major surgery, culminating in a radical hysterectomy, a vaginectomy and the removal of six lymph nodes from around the cervix to test for the spread of the disease.

Now, two months after surgery, she is exhausted and in pain and acknowledges that she and her family have been traumatised by the sequence of events.

'It's hard not to wonder whether, if I had gone earlier, the cancer would not have advanced to the stage where I had to have a hysterectomy.

'Not only was I forced to accept that we would have no more children but my whole life and that of my family was turned upside down.'

She is not the only woman who has neglected to have regular cervical check-ups.

According to recent figures issued by the Department of Health, there is a large-scale drop in smear test attendance, particularly among the young.

Of the 4.4 million women aged 25-64 who were invited for cervical screening in England in the financial year 2005/2006, one million did not attend.

Currently, the problem is most acute in the youngest age band, 25-29. Only 69.4 per cent of those invited attend their smear tests, 1,300 fewer each week than in 1995. In the 30-34 age band, attendance is less than 80 per cent.

Wales and Scotland have also produced evidence of a fall-off in numbers attending smear tests, particular in the younger age groups.

All women between the ages of 25 and 64 registered with an NHS GP are offered regular cervical smear tests, once every three years, until the age of 49 and then every five years thereafter, as post-menopausal women have a very low incidence of cervical cancer.

All age groups are offered the same procedure - a sweep of the neck of the womb, or cervix, to remove sample cells for analysis. This looks for early cell changes that could indicate the initial, and therefore treatable, signs of cancer.

Early detection and treatment can prevent the development of 75 per cent of cancers.

Dr Anne Szarewski, clinical consultant for Cancer Research UK, who is working on one of the major causes of cervical cancer, the human papilloma virus (HPV), says the reasons for the decline in attendance are complex.

'In part, the cervical screening programme is a victim of its own success. Early detection is preventing invasive cervical cancer in many cases, making it a cancer that fewer women have heard about.

'In the younger age group in particular, women simply don't know what it is, or they have the perception that it's a disease affecting older women, which is not the case.

'Another factor may be that the age limit for cervical screening was raised two years ago from 20 to 25.

'While it is true that the peak age for cervical cancer to strike is the late 30s, there are now fewer chances to pick up affected women early through screening.

'My opinion is that a programme of vaccination against HPV, given to pre-teens, might be one way of tackling the problem.'

Michelle has her mother, Susan, to thank for finally persuading her to go for a smear test in February 2006.

'My mum and I are very close and she knows everything that's going on in my life. In fact, often she is more on the ball than I am.

'It was my mum who nagged me to finally make the appointment for a smear test that I was too busy to think about. It was entirely thanks to her that it finally made it on to my huge list of things to do.

'I'm not one of those people who worries about it being uncomfortable or painful, so I wasn't fazed at all.'

In April, the results came back as 'abnormal' and Michelle was then booked in at St Peter's Hospital, Chertsey, for a colposcopy, a minor exploratory procedure under local anaesthetic, which uses a special binocular camera.

'It was all very straightforward and the consultant, Mr Ahmed Elias, was very calm and explained exactly what he was going to do - but I did start to become anxious about what they would find.'

The results took more than a month to come back.

'I mistakenly took this as a positive sign, but it turned out it was simply that results often take a while to be processed, whatever the outcome.

'There is no average wait for test results and it can vary wildly from days to months.'

In mid-June, Mr Elias's secretary rang to summon Michelle to see the consultant next day.

'Alarm bells were ringing by this stage,' she admits. 'She said she couldn't tell me anything and was very insistent that I kept the appointment.

'I took my husband, Steve, along with me and by the time we arrived I was in a bit of a state, although I was trying to keep calm for both our sakes. I remember being told that they had found abnormal cells that were pre-cancerous, but I don't recall cervical cancer being discussed.

'I was given the option of laser treatment, which would temporarily remove abnormal cells on the surface of the cervix. However, I was told they would grow back and I would need to repeat the procedure every six months.

'The alternative was a simple hysterectomy, which would clearly mean accepting that our family was complete and we couldn't have any more children.

'I'd had a miscarriage a year earlier and wasn't 100 per cent sure I'd want to rule out the chance of more children for ever, but Steve felt strongly that I should get rid of what I believed to be pre-cancerous tissue, as did my mum and dad.

'After recovering from the shock and thinking it through, I agreed that the hysterectomy was the best thing for all of us as a family, including our children, James, 13, and Francesca, nine.'

Michelle had the operation privately after her worried parents cancelled their summer holiday to pay for it, insisting that the surgery should take place straight away, and the hysterectomy was carried out at the Princess Margaret Hospital, in Windsor, in early July.

She was left tired, sore and with a 5in abdominal scar, but was comforted by the thought that the worst was over. But then Michell was dealt a shattering blow.

'At my check-up in August, Mr Elias told me the cancer was more advanced than expected. I was there with my mum and we just looked at each other in amazement.'

He said: 'You did know you had cancer?' The word cancer came as a huge shock. It was my 35th birthday the next day and I kept thinking how I had cancer at 35 and I was going to die. The rest of the appointment passed in a blur.'

Following an MRI scan of the abdominal area, to check for obvious signs that the cancer had spread, she was referred to oncologist Anil Taylor.

He told her that he and his colleague, Simon Butler-Manuel, would need to perform a radical hysterectomy - a far more extreme procedure than her earlier 'simple' hysterectomy - involving the removal of an amount of soft tissue in the pelvis and a vaginectomy that would remove the cervix and 3cm of the vagina bordering the cervix.

Six lymph nodes were also removed as a precaution, to check if it had spread any further. Fortunately, they were clear of cancer and there was no sign that it had spread.

Michelle had the hysterectomy, via keyhole surgery, at the Royal Surrey Hospital in Guildford, in early December. Two cysts and a Fallopian tube were also removed.

Unfortunately, her bladder was nicked during the operation and she was left using a catheter - a soft tube that artificially drains urine from the bladder - for several weeks while her bladder healed.

On December 22, after the lymph nodes were tested, she was told she was clear of cancer, although she will have to be regularly monitored by her consultants for the next two years.

'I thought I'd be relieved, but I was consumed by the pain and discomfort that followed the operation and could not do anything with the children. It was a very difficult Christmas.

Steve was a real star, taking on the responsibility for housework and childcare. But I know the realisation that I had cancer hit him very hard.

'He's not someone who talks a lot, but he is definitely not as laidback and happy as he used to be.

'I've seen him chewing his cheeks, a sign that he is feeling stressed. I think it was the second operation that brought it home to him that he could lose me.

'I've been completely upfront with the children about having cancer. My son James seems unaffected, but it's hard to know what he is keeping inside.

'Francesca, on the other hand, has spent a lot of time bawling her eyes out. Only time will tell if it's had a deeper impact.

'I've not wanted to burden my family too much, but I don't know anyone else in my shoes. I've relied on help and support from the charity Jo's Trust. They have given me more information about my condition and helped me to deal with my cancer diagnosis.'

Sex is something that Michelle has not yet considered. 'I have not asked Steve how he feels about sex and neither has he asked me. I do not know whether that is because he is just being considerate and giving me space, or whether he feels afraid about it after all the surgery I've had.

'Either way, the only thing I'm worried about is getting back on my feet and feeling normal again.

'I also want to tell everyone I meet how they must not miss their smear tests. In the past year, I feel I've been on a roller-coaster and I'm still dizzy from the speed of events.

'I had cancer and did not know it, which is hard to accept. It shows that even a small delay could cost you your life.'

For more information on cervical cancer, contact Jo's Trust at www.jotrust.co.uk